final Flashcards
1
Q
COPD
A
Air in, air gets trapped and they can’t get the air out
Secretions
2
Q
CPOD & O2
A
Supplemental O2 removes a COPD patient’s hypoxic (low level of oxygen) respiratory drive causing hypoventilation which causes higher carbon dioxide levels, apnea (pauses in breathing), and ultimately respiratory failure.
3
Q
asthma
A
Chronic airway inflammation = bronchial constriction
Wheezing and difficulty breathing
Tightness of chest
Can’t get CO2 out
Auscultate the lungs: inspiratory wheeze = inflammation & constriction
Appear cyanotic & edema
4
Q
chronic bronchitis
A
Continuous inflammation of bronchi
Excessive secretion of mucus
5
Q
emphysema
A
Alveolar wall destruction & enlarged air spaces
Overinflation of air sacs
Decreases working the alveoli and impaired gas exchange between O2 & CO2
6
Q
bronchodilators
A
B-adrenergic agonists (blue container)
Anticholinergic drugs (green container)
Xanthine derivatives
7
Q
non-bronchodilators
A
Corticosteroids
Leukotriene receptor antagonists (LTRAs)
8
Q
B – adrenergic agonists (quick symptoms relieve) indications
A
Used to treat severe bronchospasm
Emergency medication
For quick relief of symptoms
9
Q
B – adrenergic agonists mechanism of action
A
Relaxes bronchial smooth muscles which causes dilation of bronchi & bronchioles
Imitates norepinephrine on B2 cells = causes vasodilation & increases airflow
10
Q
B – adrenergic agonists examples
A
Salbutamol (ventolin) short acting (main)
Salmeterol xinafoate (serevent) long acting
Combination (steroid & B-adrenergic – symbicort or advair)
11
Q
B – adrenergic agonists adverse reactions
A
Tachycardia
Palpitations
Tremor
Nervousness / anxiety
Hypertension / hypotension
Headache
12
Q
If used too frequently, dose-related adverse effects may be seen because B-adrenergic loses its B2 specific action, especially at larger doses (t/f)
A
TRUE
13
Q
Anticholinergics (slower) indications for use
A
Maintenance & prevention of bronchospasm
Bronchodilator
Not 1st line treatment for acute symptoms, use after salbutamol!!!
14
Q
what is the order of medications for respiratory
A
blue (salbutamol) and then green (ipratropium)
15
Q
anticholinergics mechanism of action
A
Prevents bronchial constriction by blocking acetylcholine (Ach) receptors
Block constriction
Reduce secretions
Onset: 5-15mins, peak 2-3hr
16
Q
anticholinergic examples
A
Ipratropium bromide (atrovent)
Tiotropium bromide monohydrate (spiriva)
Salbutamol & ipratropium combination (combivent)
17
Q
anticholinergic adverse effects
A
Dry mouth or throat
Nasal congestion
Heart palpitations
Urinary retention
GI problems
Increased intraocular pressure
Headache
Coughing anxiety
18
Q
Xanthine derivatives indication of use
A
Used with chronic bronchitis & emphysema
For prevention of symptoms
19
Q
Xanthine derivatives mechanism of action
A
Causes bronchodilation by inhibiting phosphodiesterase enzyme results in smooth muscle dilation
20
Q
Xanthine derivatives examples
A
Theophylline (oral medication
Aminophylline (IV only)
21
Q
Theophylline considerations
A
Short therapeutic window between therapeutic and toxic
Blood work done frequently
22
Q
Aminophylline special use
A
Used for status asthmaticus
23
Q
Xanthine derivatives adverse effects
A
Cardiac irregularities
Tachycardia, palpitations, ventricular dysrhythmias
GERD – nausea, vomiting, anorexia
Increased urination
Hyperglycemia
24
Q
Corticosteroids indications of use
A
Anti-inflammatory (major)
For management of difficult to treat asthma/resp illnesses
Allergic rhinitis
25
corticosteroids mechanism of action
Controls inflammatory responses
Increases the effects of B-agonists (bronchodilation)
26
corticosteroids examples
Budesonide (pulmicort), fluticasone propionate (flovent), prednisone, combination with B-agonist-advair
27
corticosteroids adverse effects
Pharyngeal irritation
Cough & dry mouth
Oral fungal infections
PO corticosteroids provide more systemic effect & therefore adverse effects are more systemic
Susceptibility to infection
Fluid and electrolyte imbalance
Endocrine effects (including hyperglycemia)
Osteoporosis
28
Leukotriene receptor antagonists indications of use
Used for the prophylaxis and long-term treatment and prevention of asthma
Seasonal allergies/asthma
29
Leukotriene receptor antagonists examples
Montelukast (singulair) orally OD
Zafirlukast (accolate) orally BID
30
Leukotriene receptor antagonists adverse effects
Nausea
Diarrhea
Headache
Nightmares
Liver dysfunction
31
Nursing assessment respiratory
Resp assessment
Colour, accessory muscle, O2 sats, resp rate, cough, sputum, cyanotic
Environmental exposures & allergens
Smoking habits
Emotional status (anxiety, stress, fear)
Allergies
Caffeine intake
Increase in adverse effects (salbutamol)
32
interventions for respiratory
Discuss adherence to medication regimen
Demonstrate proper administration of inhaled drugs
Reassess respiratory status & breath sounds
Instruct pt to rinse mouth with water after use of inhaler or nebulized drug
(Esp steroid and anticholinergic to prevent dryness and mucosal irritation)
Wash inhaler, spacer, and nebulizer qweekly with warm soapy water
Pt education
33
how to use medications (puffers)
2 puffs of same medications = 1-2 mins b/w each puffs
Can put 2 puff in aerochamber
2 different medications = 2-5 mins b/w medications
Exhale, inhale & puff, hold 10 secs, exhale, repeat
34
adrenal gland medications
- cortex = corticosteroids (glucocorticoids, mineralocorticoids)
- medulla = epinephrine, norepinephrine
35
Corticosteroid levels regulated by
hypothalamic-pituitary-adrenal (HPA) axis (give steroids in morning as they reflect HPA)
36
HPA order
Level of cortco low --> corticotropin releasing hormone released from hypothalamus --> anterior pituitary --> ACTH released --> adrenal cortex --> production of corticosteroids reach peak level ---> signal sent to hypothalamus --> HPA inhibited
37
Glucocorticoids
- major inflammatory actions
- regulates carbo, protein, lipid metabolism
- maintenance BP
38
mineralocorticoids
- BP control
- maintenance pH levels
39
Adrenal system over-secretion
Cushing's syndrome – over secretion of adrenal hormones
40
Glucocorticoid hypersecretion
redistribution of body fat from arms & legs to face, shoulders, trunk, and abdomen, characteristic “moon face”
41
Aldosterone hypersecretion
increased water & Na retention & muscle weakness from K loss
42
causes of adrenal over secretion
tumor, excessive administration of steroids
43
Adrenal system under-secretion
Addison's disease
Under secretion of adrenal hormones (Decreased blood Na & glucose levels, increased K levels )
44
symptoms addisons disease
Hyperpigmentation, weakness, headache, fatigue, nausea & vomiting, anorexia, dehydration, weight loss, confusion, fever, abdo pain, diaphoresis, low BP
45
Mineralocorticoids mechanism of action
Acts on distal kidney tubule --> sodium reabsorption into blood --> pulls water & fluid with it --> help regulate edema & BP (HTN)
Promotes H & K excretion
Helps regulate blood pH
46
mineralocorticoids used for
addisons disease
47
Glucocorticoids examples
hydrocorticsone, cortisone, prednisolone, dexamethasone
48
Glucocorticoids mechanism of action
Inhibition of inflammatory & immune responses
Promote breakdown of protein, production of glycogen in liver, & redistribution of fat from peripheral areas to central areas of body
49
how does glucocorticoids inhibit or control inflammatory response
1. stabilizing cell membranes of inflammatory cells
2. decreasing permeability of capillaries to inflammatory cells
3. decreasing migration of WBCs into inflamed areas
50
Indications of corticosteroids
Adrenocortical deficiency
Bacterial meningitis
Cerebral edema
Collagen diseases (systemic lupus erythematosus)
Dermatological diseases
Endocrine diseases (thyroiditis)
GI diseases (ulcerative colitis)
Ocular disorders
Leukemia & lymphoma
Bronchospasms (via inhalation route)
Allergic rhinitis (nasal route)
Inflammations of ear, eye, skin (topical route)
Exacerbation of chronic respiratory illnesses (asthma & COPD)
51
nursing assessment steroids
Assess nutritional & hydration status, baseline weight, intake & output, VS, skin condition, immune status
Assess muscle strength
Baseline lab values
Avoid alcohol, caffeine, aspirin, NSAIDs
52
nursing interventions steroids
Healing may be decreased with long term therapy
Avoid contact with people with infections
Assess therapeutic response & adverse effects to monitor effectiveness
ADDISONIAN CRISIS
Oral given with milk, food, and antacids
IM = administered into large muscle with rotation of sites
Topical = skin clean & dry, gloves worn
Nasal = clear nasal passage first, pt breathes in through nose with administration
Inhaled = fungal infections common, rinse mouth with water
53
when is the best time to give glucocorticoids
Best time to give exogenous glucocorticoids is early in morning = minimizes adrenal suppression
54
pt education steroids
Never stop taking medications abruptly or alter dose
Long term effects of glucocorticoid therapy
Bone health & prevention of falls
Signs and symptoms of acute adrenal insufficiency
Document response to treatment, BP, daily weight, adverse effects
Maintain low sodium & high potassium diet
55
Anxiolytics
promote relaxation, decreased anxiety
56
Sedatives – hypnotics
Promote relaxation and induce sleep
57
Anxiolytics used for sleeping referred to a
sedative-hypnotics
58
difference b/w anxiolytics & sedatives
depends on dose
59
what kind of drugs used to treat anxiety and insomnia
benzos
60
what is the antidepressants used to treat insomnia
trazodone
61
Daytime anxiety can manifest as a
nighttime sleep disturbance – unable to turn off their worries
62
Lack of sleep can present as anxiety, fatigue, and decreased functioning
TRUE
63
Anxiety – pathophysiology
Excess of excitatory neurotransmitters (norepinephrine) or deficiency of inhibitory neurotransmitters (GABA)
Neuroendocrine factors also play role – when under stress, corticotropin releasing factor (CRF) increases release of norepinephrine
Serotonin also involved, hence effectiveness of SSRIs treating anxiety
64
benzo OD fatal or nonfatal?
not fatal unless combo w/ CNS depressants
65
benzo used for
sedation, reduce anxiety, muscle skeletal relaxation, anticonvulsant effects
66
benzo potentiates
GABA
GABA calms you, calms down dopamine
67
do benzo supress rem sleep
NOOOOOOO
68
Diazepam, flurazepam, and chlordiazepoxide form active metabolites that have long-acting half-lives (>24hrs) & tend to
accumulate, especially in older adults or those with impaired liver function
69
Alprazolam, lorazepam, clonazepam, oxazepam, and temazepam have intermediate acting ½ lives 6-24hrs which
don’t have active metabolites and generally do not accumulate
70
Midazolam & triazolam have short acting ½ lives <6 hours (t/f)
TRUE
71
diazepam used effectively in TX
GAD, muscle relaxant, alcohol withdrawal
72
lorazepan used to TX
GAD, agitation, alcohol withdrawal
73
midazolam
IV only (sedation, anaesthesia)
74
clonazepam
seizures, panic, agitation, mood stabilizer
75
benzo disadvantages
Potentially habit forming & addictive – limit to 2 week use
Shouldn’t be used beyond 4 weeks
Some have long ½ life & can accumulate
Memory & intellectual impairment
Hangover
Reduced motor coordination
Paradoxical confusion, agitation, insomnia especially with pediatric & other adult clients
76
adverse effects benzo
CNS effects (Diplopia, tremors, ataxia (impaired coordination), drowsiness, headache, nausea, vomiting)
Autonomic effects
(Changes in libido, constipation, incontinence, urinary retention, hypotension, tachycardia, nasal congestion)
Accumulations effects
(Confusion, hypoactivity, intellectual impairment)
77
Mild withdrawal symptoms occur within
6-12 weeks
78
mild withdrawal sx
Anxiety, panic, hand tremors, sweating restlessness, insomnia, weakness, aches, pains, blurred vision, palpitations
79
severe withdrawal sx
Irritability, agitation, rage, nervousness, diarrhea, vomiting, sweating, seizures
80
TX of withdrawal of benzo w/
benzo
81
to prevent withdrawal of benzo
taper drug by 10-25% every 1-2 weeks over 4-16 weeks
82
drug to reverse benzo toxicity
flumazenil
83
chloral hydrate suppress rem
NO
84
chloral hydrate mechanism of action
GABA
85
chloral hydrate s/e
drowsiness, N & V. stomach pain, headache
86
zopiclone
Differs structurally from benzos but has a similar effects, binds with benzo receptors
Indicated for symptomatic relief of transient & short term (7-10 days) insomnia characterized by difficulty falling and remaining asleep, and/or early morning awakenings
87
zopiclone and REM sleep
Delayed onset of REM sleep, does not reduce total duration of REM periods
88
considerations with zopiclone
Should not be prescribed in quantities larger than 1 month
Risk of dependence
Overdose can be fatal
Rebound insomnia common
Taper slowly
Less side effects than other sedative hypnotics
89
antihistamine mechanism of action
bind to HA receptor to reduce negative symptoms
90
antihistamines s/e
- drowsiness, dry mouth, urinary retention, blurred vision, paradoxical effects
91
dimenhydrinate
gravol
92
diphenhydramine
benadryl
93
Nursing process, patient teaching sedatives
Nursing Implications for all sedative/hypnotics:
Use with caution in the elderly and pediatric populations
Baseline vitals – including postural B/P
Hypnotics: 15-30 minutes pre bedtime for maximum effectiveness
Avoid ETOH and other CNS depressants
Avoid grapefruit juice
Pregnancy and breast feeding
94
hematopoiesis
Formation new blood cells (red, white, platelets)
Hemoglobin = O2 and remove CO2
95
Hematocrit
Important marker for anemia
Percentage of WBC & RBC in blood
96
lifespan of RBC
Lifespan = 120 days (significant)
More than 1/3 made of hemoglobin
97
anemias
Maturation defects (120 days (lifespan))
Excessive destruction of RBCs (hemolytic anemias)
98
maturation defects
Lack of B12 or folic acid
Blood loss, child birth, GI bleeding, periods
Cytoplasmic
Nuclear
99
Excessive destruction of RBCs (hemolytic anemias)
Genetic deficit = sickle cell disease (immature RBC)
Intrinsic RBC abnormalities = Sickle cell
Extrinsic mechanisms = Mechanical (blood loss)
100
Erythropoiesis – stimulating agents (stimulates RBC production from bone marrow)
Epoetin alfa
Biosynthetic form of hormone erythropoietin (produced in kidney)
101
Erythropoiesis – stimulating agents treat
**anemia associated end-stage renal disease**, chemo – induced anemia, anemia associated with antiretroviral medications
102
Erythropoiesis – stimulating agents ineffective w/o adequate
iron stores & bone marrow function
You must be able to be able to store iron (ferritin)
103
Erythropoiesis – stimulating agents contraindications
Allergy
Hypertension
Hemoglobin levels
Head and neck cancers
Thrombosis
104
hemoglobin levels for Erythropoiesis – stimulating agents
100mmol/L for cancer pt
130mmol/L for pt w/ kidney disease (Don't want pt to have if hemoglobin too high = Too high = viscosity)
105
adverse effects Erythropoiesis – stimulating agents
Hypertension, fever, headache, pruritus, rash, N & V, arthralgia (joint stiffness), injection site reaction
106
iron
O2 carrier in hemoglobin & myoglobin
Iron & oxygen binding protein in the muscle
107
Foods enhance absorption iron
Orange juice, veal, fish, ascorbic acid
108
Foods impair absorption iron
Eggs, corn, beans, cereal products containing phytates
109
Oral iron are available as ferrous salts
(fumarate (33% iron), sulphate (20% iron), gluconate (11.6% most common))
110
iron indications
Prevention & treatment of deficiency
Admin alleviates symptoms of anemia but underlying cause of anemia needs to be corrected
111
adverse effects of iron
Nausea, vomiting, diarrhea, constipation, stomach cramps, pain
Most common cause of pediatric poisoning (Schedule 2)
Black darkened stools (dark green)
Temp discolour teeth (liquid oral)
Injectable (pain upon injection)
112
Toxicity iron
Symptomatic & supportive measures
Suction & maintenance of airway
Correction of acidosis
Control of shock & dehydration with IV fluids or blood
Oxygen
Vasopressors
Severe symptoms (coma, shock, seizures) = Chelation therapy w/ deferoxamine mesylate
113
dextran
Anaphylactic reactions (major orthostatic hypotension & fatal)
Test dose of 25mg admin before full dose then remainder given 1 hr after
114
Ferric gluconate
Indicated for repletion of total iron content in pt w/ iron deficiency anemia undergoing hemodialysis
Risk of anaphylaxis is much less than dextran
Doses higher than 125mg associated with increased adverse effects = Abdominal pain, dyspnea, cramps, itching
115
Folic acid
B-complex vitamin (B9)
Essential for erythropoiesis
116
primary uses folic acid
Deficiency
During pregnancy = prevent neural tube defects (Trying to get prego = take 1 month before)
117
Cyanocobalamin – vitamin B12
Treat pernicious anemia & other megaloblastic anemias (large, abnormal, immature RBCs)
118
B12 & folic acid = building blocks for RBC (t/f)
TRUE
119
Nursing process: assessment anemia
Pt history & medications, allergies
Assess potential contraindications
Assess baseline lab values, especially hemoglobin, hematocrit
Obtain nutritional assessment
Hematochezia = Frank or fresh blood in stool
120
Dextran contraindicated in all anemias except for
iron-deficiency anemia
121
Interventions anemia
Liquid preparations = follow manufacturer’s guidelines on dilution & administration
Instruct pt to take liquid iron through a straw to avoid staining tooth enamel
Oral forms taken b/w meals for max absorption by can be taken with meals if GI distress occurs (Given with juice NOT milk or antacids = Because milk & antacids create a barrier)
Avoid esophageal corrosion = remain upright for 30 mins after
Pt encouraged to eat foods high in iron & folic acid
122
Triglycerides
energy sources & stored in adipose tissue
123
Cholesterol
used to make steroid hormones, cell membranes, bile acids
124
Low-density lipoprotein
Produced by liver
Transports endogenous lipids to peripheral cells
125
High-density lipoprotein (HDL)
Responsible for “recycling” of cholesterol
“good cholesterol”
126
1st line therapy for hypercholesterolemia (elevated LDL)
Hydroxymethylglutaryl – coenzyme A (HMG-CoA) reductase inhibitors (statins)
127
Most potent LDL reduces
Pravastatin sodium
Simvastatin
Atorvastatin
Fluvastatin sodium
Rosuvastatin calcium
Lovastatin
128
statin mechnism of action
Inhibit enzyme which used by liver to produce cholesterol
Lower rate of cholesterol production = increasing the amount of LDL receptors in liver
129
statin adverse effects
Mild, transient GI disturbances (constipation)
Rash
Headache
Myopathy (muscle pain), possibly leading to rhabdomyolysis (serious condition)
Do not use for patients with elevated liver enzymes or liver disease
130
Rhabdomyolysis
Breakdown of muscle protein
Lead to acute kidney injury
Early intervention = reversible with discontinuation of drug
Report STAT signs of toxicity (muscle soreness or urine colour (tea-coloured))
131
avoid grapejuice for rhabdomyolysis
YES
132
Atorvastatin calcium & simvastatin
Lowers total & LDL cholesterol levels & triglyceride levels
Raises HDL (good cholesterol)
Dosed once daily, evening meal or bedtime to correlate diurnal rhythm (liver produces most cholesterol)
133
Bile acid sequestrants examples
Cholestyramine resin, colestipol hydrochloride, colesevelam
134
Bile acid sequestrants mechanism of action
Prevent resorption of bile acids from small intestine
Bile acids necessary for absorption cholesterol
135
can Bile acid sequestrants be used with statins
YES
136
adverse effects Bile acid sequestrants
Constipation
Heartburn, nausea, belching, bloating = Tend to disappear over time
Mild increases in triglyceride levels
137
B vitamin niacin (vitamin B3, nicotinic acid) adverse effects
Flushing (caused by histamine release)
Pruritus
GI distress
138
Fibric acid derivatives (fibrates) examples
Bezafibrate, gemfibrozil, fenofibrate
139
Fibric acid derivatives (fibrates) be given with statin
YES increase risk of myositis, myalgia, rhabdomyolysis
140
Fibric acid derivatives (fibrates) adverse effects
Abdominal discomfort, diarrhea, nausea,
Blurred vision, headache
Increased risk of gallstones
Prolonged prothrombin time
Increased enzyme levels??
141
Cholesterol absorption inhibitor (ezetimibe)
Inhibits absorption of cholesterol & related sterols from small intestine
142
Cholesterol absorption inhibitor (ezetimibe) used with statin
YES
143
garlic
antispasmodic, antiseptic, antibacterial, antiviral, antihypertensive, antiplatelet, lipid reducer
144
garlic possible interactions
warfarin, diazepam, protease inhibitors
145
garlic may enhance
bleeding with nonsteroidal anti-inflammatory drugs (NSAIDs)
146
Assessment lipids
Before therapy, health & medication history
Dietary patterns, exercise level, weight, height, VS, tobacco & alcohol
Contraindications, conditions that require caution, drug interactions
Results of baseline liver function
147
lipids contraindicated
Biliary obstruction
Liver dysfunction
Active liver dysfunction
148
interventions lipids
Long term therapy = supplemental fat-soluble vitamins (A, D, E, K) with bile acid sequestrants
Refer to guidelines for admin time & meals
Educate diet & nutrition
Educate on proper procedure for taking meds
Powder forms = mixed thoroughly with liquid (NOT STIRRED)
Other meds taken 1 hr before or 4-6 hours after meals to avoid interference with absorption
Minimize effects of niacin = start low & gradually increase & take with meals
Inform meds take several weeks to show effectiveness
149
niacin = Small doses aspirin or NSAIDs may be 30mins to minimize flushing
Provide education about NSAIDs & aspirin
TRUE
150
Evaluation lipids
Instruct to report persistent GI upset, constipation, abnormal bleeding, yellowing skin
Monitor for adverse effects (increased liver enzyme labs & signs of myalgias)
Monitor for therapeutic effects = Reduced cholesterol & triglyceride levels
151
Coagulation system “cascade”
Each activated factor serves as catalyst that amplifies next reaction
Results = fibrin (clot-forming substance)
152
Thrombus
Aggregation of platelets, fibrin clotting factors & cellular elements of blood that is attached to interior wall of vein or artery
153
Anticoagulants
Inhibit action or formation of clotting factors
Prevent clot formation
No direct effect on blood clot that is already formed
Prevent intravascular thrombosis by decreasing blood coagulability
Used prophylactically to prevent
154
Antiplatelet drugs
Inhibit platelet aggregation
Prevent platelet plugs
155
Thrombolytic agents
breaks down formed clots)
156
Antifibrinolytics agents
(promote blood coagulation & clot formation)
157
action of heparin
Inhibit clotting factors IIa (thrombin), Xa, IX
158
Low-molecular-weight heparins examples
Enoxaparin
Dalteparin
Nadroparin calcium
Tinzaparin sodium
159
Unfractionated heparin sodium
Frequent lab monitoring for bleeding times (aPTT – how long does it take for blood clot to form in sec) - normal time = 25-35 secs
Weight-based protocol
160
lab monitoring needed for low molecular heparins
NO
161
Direct acting Xa inhibitors action
nhibit factor
Fondaparinux, rivaroxaban, apixaban
162
Warfarin
Inhibit vitamin K synthesis by bacteria in GI tract
163
warfarin action
Inhibit vitamin K-dependent clotting factors II, VII, IX, and X which normally synthesized in liver
164
final effect of warfarin
prevention of clot formation
165
lab monitoring for warfarin
Careful monitoring of prothrombin time(PT)/international normalized ratio (INR)
166
therapeutic INR warfarin
2-3.5 sec
167
maintenance dose of warfarin determined by
INR
168
mechanism of action warfarin
Work on different points of clotting cascade
Prevent intravascular thrombosis by decreasing blood coagulability
Do not lyse existing clots
169
warfarin indications
Prevent clot formation in certain settings in which clot formation is likely (Unstable angina, Atrial fibrillation, Indwelling devices (mechanical heart valves), Conditions in which blood flow may be slowed & blood may pool (prolonged periods of immobility))
170
contraindications warfarin
Allergy
Acute bleeding process or high risk of
Warfarin strongly contraindicated in pregnancy
Low-molecular-weight heparins = indwelling epidural catheter risk of epidural hematoma
171
adverse effects warfarin
Bleeding = Risk increases with increased dosages (May be localized or systemic)
Heparin-induced thrombocytopenia
Nausea, vomiting, abdominal cramps, thrombocytopenia
172
symptoms of toxic effects of heparin
Hematuria
Melena (blood in stool)
Petechiae
Ecchymoses
Gum or mucous membrane bleeding
173
antidote for toxic effects of heparin
protamine sulphate (reverse 100 units)
174
warfarin adverse effects
Bleeding, lethargy, muscle pain, skin necrosis, “purple toes” syndrome
175
toxic effects of warfarin mayy take
May take 36-42 hours before liver can resynthesize enough clotting factors to reverse warfarin effects
176
antidote for warfarin
vitamin K
Vitamin K can quicken return to normal coagulation
Vitamin K given, warfarin resistance will occur for up to 7 days
177
Antiplatelet drugs
Prevents clot formation by inhibiting platelet adhesion at beginning of cascade
178
antiplatelet examples
Acetylsalicylic acid
Clopidogrel bisulfate
Ticagrelor
179
mechanism of action antiplatelet
Affect normal function of platelets to prevent platelet adhesion to site of blood vessel injury
180
indications antiplatelet
Stroke, TIA, post MI thrombo prevention
Some used in conjunction with anticoagulant warfarin as prophylaxis for CVA, PE, DVT
181
ASA s/e
Nausea, vomiting, GI bleeding, diarrhea, thrombocytopenia, agranulocytosis, anemia
182
clopidogrel s/e
Chest pain, abdo pain, diarrhea, epistaxis, headache, dizziness, fatigue
183
assessment coagulants
History, medications, allergies
Contraindications
Baseline VS, lab values (PT, INR, PTT)
Potential drug interactions
History of abnormal bleeding conditions
No IM injections with anticoagulants
184
Heparin nursing process
IV doses double-checked (high alert)
Ensure subcut dose given SC
Subcut given areas of deep subcut fat & sites rotated
Don't give within 5cm of umbilicus, abdo incisions, open wounds, scars, drainage tubes, stomas, areas of bruising
Don't aspirate (hematoma)
IV = bolus or IV infusions
Anticoagulants effects seen immediately
Lab values done daily to monitor coagulation effects (aPTT)
Protamine sulphate given as antidote in case of excessive anticoagulation
185
Low-molecular-weight heparins nursing process
SC in abdo
Rotate sites
Protamine sulphate given as antidote
186
Warfarin nursing process
May start if pt still on heparin until PT/INR level indicate adequate anticoagulation (cross-over therapy or bridging therapy)
Full therapeutic effects take days
Antidote is vitamin K
Many herbal products potential interactions = increased bleeding may occur
Capsicum pepper, garlic, ginger, ginkgo, st. John's wort, feverfew
187
Anticoagulants & antiplatelet: nursing education
Importance of reg lab testing
Signs of abnormal bleeding
Measures of prevent bruising & tissue injury
Wearing medical alert bracelet
Avoid foods high in vitamin K (tomatoes, dark leafy green)
Consulting the physician before taking other drugs or OTC products
188
Antibiotics: All classes
Sulfonamides
B-Lactam (4 diff classes)
macrolides
Tetracyclines
Aminoglycosides
Quinolones
Miscellaneous
189
sulfonamide action
Bacteriostatic
Prevent bacterial synthesis of folic acid (B-complex vitamin) required for synthesis of purines and nucleic acid (DNA & RNA)
190
sulfa uses
Gram-positive and negative bacteria;
Treatment of urinary tract infections; pneumonia; UTI
191
sulfa adverse effects
Common allergic reactions including photophobia and skin rash; see Adverse Effects
Superinfection
192
b-lactams penicillin action
Bactericidal
Enter the bacteria via the cell wall then bind to penicillin-binding protein.
Broad spectrum
193
penicillin uses
Gram-positive and negative; Health care-acquired infections, including pneumonias, intra-abdominal infections and sepsis.
194
penicillin adverse effects
Nausea, vomiting, diarrhea, abdominal pain
Superinfection
195
penicillin nursing process
An allergic reaction to penicillin may also have an allergic reaction to other B- Lactam antibiotics.
196
B-Lactams: Cephalosporin
(5 generations available) action
Bactericidal Structurally and pharmacologically related
to penicillin;
Broad spectrum
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B-Lactams: Cephalosporin
(5 generations available) uses
Gram-positive and negative; surgical prophylaxis and for susceptible staphylococcal infections; 4th generation difficult to treat UTI
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cephalosporin adverse effects
Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema
Superinfection
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cephalosporin nursing process
Penicillin cross- sensitivity; Incidence between 1 and 4%.
200
B-Lactams Carbapenem
(broadest antibacterial action of any abx to date) action
Bactericidal
Binds to penicillin-binding proteins inside bacteria, which in turn inhibits bacterial cell wall synthesis.
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B-Lactams Carbapenem
(broadest antibacterial action of any abx to date) uses
Reserved for complicated body infections; treatment of severe or high-risk bacterial infections such as multidrug-resistant (MDR) bacterial infections i.e. MRSA.
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B-Lactams Carbapenem
(broadest antibacterial action of any abx to date) adverse effects
most serious adverse effect is seizures; 1.5% for <500mg q 6hrs and 10% > 500mg q 6hrs
Superinfection
203
nursing process B-Lactams Carbapenem
(broadest antibacterial action of any abx to date)
Cross sensitivity to PCN; Must be infused over 60 minutes
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Macrolides action
Bacteriostatic
Prevent protein synthesis within bacterial cells
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macrolides uses
“Strep” infections
Streptococcus ;
Mild to moderate URI and LRI; Haemophilus influenza;
Spirochetal infections-
Syphilis and Lyme disease;
Gonorrhea; Chlamydia.
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adverse effects macrolides
GI effects (primarily erythromycin)
N & V, diarrhea.
Fidaxomicin (Dificid): N & V, and GI bleed.
Superinfection
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nrusing process macrolides
**Fidaxomicin (Dificid) is the newest macrolide antibiotic. It is indicated only for the treatment of diarrhea associated with Clostridium difficile.
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tetracyclines action
Bacteriostatic
inhibit bacterial growth
Inhibit protein synthesis; Bind (chelate) to Ca, Mg and Al ions to form insoluble complexes
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tetracycline uses
Gram-negative and gram-positive organisms; acne in adults and adolescents; chlamydia, mycoplasma pneumonia; h.pylori; syphilis; resistant to gonorrhea.
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tetracycline adverse effects
Diarrhea
Vaginal candidiasis
Gastric upset
Enterocolitis
Photophobia
Superinfection
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nursing process tetracycline
Dairy products, antacids, and iron
salts reduce oral absorption of tetracycline; discolors of teeth
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aminoglycoside action
Bactericidal
Prevent protein synthesis; Often used in combination with other antibiotics for synergistic effects.
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aminoglycosides uses
Kill mostly gram-negative bacteria, some
gram-positive bacteria; Used for certain gram-positive infections that are resistant to other antibiotics such as Enterococcus spp., S. aureus. MRSA, ESBL
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adverse effects aminoglycosides
Nephrotoxicity; Ototoxicity [eighth cranial nerve])
Superinfection
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nursing process aminoglycosides
Must monitor drug levels to prevent toxicities
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quinolones action
Bactericidal
Alter deoxyribonucleic acid (DNA) of bacteria, causing death
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quinolones uses
Effective against gram-negative organisms and some gram-positive organisms; Potent and broad-spectrum for complicated urinary tract, respiratory, bone and joint, gastrointestinal, and skin infections.
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quinolones adverse effects
Nausea, vomiting, diarrhea, constipation, oral candidiasis, dysphagia, increased liver function
Superinfection
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quinolones nursing process
Absorption reduced by antacids, calcium, magnesium, iron, others
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gram - & +
+ = thick cell wall & outer capsule
- = small capsule w/ 2 membranes (harder time treating due to 2 membranes)
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can disinfectants be used on humans
no -- nonliving objects only
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when do you take a culture and sensitivity
BEFORE TX
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empiric therapy
tx of infection before culture information obtained
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definitive therapy
once culture obtained, abx tailored the best abx for specific bacteria
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what is the order of. medicaitons for abx
broad (wait 3 days for culture to be returned) narrow medicaiton
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subtherapeutic response
s/s not improve
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secondary infection
superinfection occurs when second infection closely follows intitial infection & comes from external source (colds, coughs)
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host factors
comorbidities & things increase suspectibility
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anaphylaxis s/s
hives, flushing, itching, anxiety, fast heart rate, tongue throat swelling
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bactericidal
kill
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bacteriostatic
inhibit growth
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sulfonamides used for
UTI
233
sulfo action
prevent bacterial synthesis of folic acid which is required for synthesis (bacteriostatic)
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sulfo can be used for UTI but what else
pneumonia, MRSA
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sulfo is a 2 combo drug that causes what kind of effect
synergistic
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most common side effects sulfo
N & V diarrhea photosensitivity
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b lactams 4 categories
penicillins
cephalosporins
carbapenems
monobactams
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pencillin action
bactericidal (kill)
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penicillin used
pneumonias, abdo infections, sepsis
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ppl allergic to penicillin are at increase risk of allergy to
other b lactams abx
241
common s/e penicillin
N & V diarrhea abdo pain
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cross sensitivity
cephalosporins chemically similar to penicillin thus ppl with allergic to penicillin may have allergy to ^^
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1st gen cephalo used fr
surgical prophylaxis & staph infections
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2nd gen cephalo used for
surgical prophylaxis
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3rd gen cephalo
broad spectrum
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4th gen cephalo used for
un/complicated uti
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cephalo s/e
ando cramps rash redness edema itchy
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which med used for MRSA in carbapenems
imipenem
249
how long does carbapenems be infused over
60 mins
250
monobactams used for
cystic fibrosis
251
which med usded for c diff
macrolides = fidaxomicin
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which med ruins teeth
tetracycline
8 years or young = tooth discolouration occurs if abx binds to calcium in teeth
253
during assessment process of abx what some things need to look for
- allergics
- hx
- labs
- interactiions'
- superinfections (yeast infections)
- tetracycline reduce effectiveness of contraceptives
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with abx you need to avoid
antacids, antidiarrheal, dairy, calcium, iron = reduce tetracycline absorption
consume drug 2 hr before or 3 hrs after ^^^
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which sulfo how much fluid?
2-3L
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penicillins may require pt to supplemental
probiotics as it kills all gut bacteria
257
VRE is usually seen in
UTI
258
aminoglycosides considerations
trough levels to prevent toxicities
12 hrs after dose
30 mins before morning dose
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aminoglycosides adverse effects
nephrotoxicity, ototoxicity
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giving 2 abx, which one given first
ex: b lactam given first as it breaks down cell wall of bacteria & allow aminoglycosides to gain access to ribosomes to kill
261
quinolones work good for
complicated uti
262
vancomycin considerations
trough levels d/t heptatoxicity
MRSA
263
what abx does red man syndrome occur
vancomycin
264
what is red man snydrome
flushing erythema itching of head face neck upper truck
265
why does red man syndrome occur
infusing abx too quickly
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how do you assess for ototoxicity & nephrotoxicity
o - hearing loss, tinnitus, fullness in ear
n - BUN & Cr
267
what do you assess in linezolid
concurrent use of ssri risk of serotonin syndrome
268
fluconazole s/e
- n & v, diarrhea, stomach pain, increased liver enzymes
269
nystatin s/e
n & v, anorexia, diarrhea, rash, hives
270
how to admin nystatin
oral = dropped directly on tongue & held in mouth as long as possible & then swallowed = swish med thoroughly in mouth before swallowing
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WBC levels
5,000 - 11,000
272
PLTs levels
150,000 - 400,000
273
INR sec levels
0.8-1.2
274
NA levels
136-145
275
lithium maintenance <66yrs
0.6-1.0
276
LFT
ALT (enzyme)
277
H A1C
< 7%
278
creatinine
f = 44-97
m = 53-106
279
valporic acid
350 - 830
280
hemoglobin
m = 140-180
f = 120-160
281
k+
3.5-5
282
fasting glucose nondiabetic
4-6
283
GFR
> 90 ml/min
284
c-reactive protein
< 0.3 - 1.0
285
extrapyramidal symptoms include
dystonia
akathisia
akinesia
parkinsonism
rabbit syndrome
pisa syndrome
tardive dyskinesia
286
anticholinergic side effects
blurred vision
dry mouth
urinary retention
psychomotor agitation
tachycardia
dizziness
decreased BP
287
1st gen antpsychotics
- loxapine
- haloperidol (haldol)
- flupenthixol (long acting)
- trifluoperazine
- methotrimeprazine (nozinan)
- chlorpromazine (largectil)
288
2nd gen AP
clozapine (clozaril)
risperidone (risperdal)
olanzapine (zyprexa)
quetiapine (seroquel)
289
acute dystonic reaction
- severe involuntary muscle spasms
- difficulty swallowing
- stiff neck
- thick tongue
- extreme facial grimacing
290
akathisia
- need for movement
- restlessness/pacing
- "my nerves are jumping"
- nervous energy
291
akinesia
immobility, weakness
complaints of fatigue
lack of muscle movement
292
parkinsonism
resting tremor
shuffling gait
mask-like face
drooling
293
TD
uncontrollable, abnormal, and repetitive movements of the face, torso, and/or other body parts.
294
hypernatremia leads to
decreased lithium concentrations
295
hyponatremia leads to
increased lithium concentrations
296
caffeine, metamucil, bronchial dilators do what to lithium
decrease
297
N & V, diarrhea, sweating, ACE inhibitors, ARBS, CCBs, NSAIDs do what to kidneys
sodium loss = retain more lithium (increase)
298
target levels of lithium in acute phase mania
0.8-1.2mmol/L
299
maintenance levels of lithium
0.6-1mEq/L
300
elderly levels of lithium
0.4-0.6mEq/L
301
mild to moderate lithium toxicity levels
1-2mEq/L
302
side effects of mild to moderate lithium toxicitiy levels
diarrhea, vomiting, fatigue, tremors, increased drowisness, uncontrolled movement, blurred vision
303
symptomsof severe lithium toxicity
delirium, slurred speech, seziuers, rapid heart rate, hyperthermia, nystagmus, confusion, kidney failure, coma
304
Choice triad:
Choice triad:
3 step process to determine pt’s medication interest
Communication model, shared learning, rapport
Where the patient is at in that moment with medication interest & choice
1. has insight, believe something is wrong = wants relief
2. motivated to use medication as they believe it will help relieve the symptoms they are experiencing
3. client believes the benefits of taking the medication are greater than the adverse effects (weighing the pros & cons)
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Medication interest model:
Medication interest model:
Communication, collaborated listening
Framework of interviewing techniques used to elicit & explore the clients beliefs/feelings regarding each step in the choice triad
